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(Note: this is part 1 of my four-part series, "Topics in Healthcare Innovation"; links to companion articles follow this post.)

Where’s Silicon Valley when we need it? The inexorable rise of healthcare costs has created not only a crisis waiting to happen, but also an urgent need for innovation – exactly the sort of thing for which Silicon Valley is justly famous. So where is it?

While entrepreneurs in the Valley and elsewhere have achieved remarkable success (at least historically) developing new drugs and devices , more fundamental innovation in healthcare delivery – particularly the sort designed to take costs out of the system -- has proved far more elusive.

It’s not for lack of trying. Almost every legendary Silicon Valley entrepreneur (see here; also here) has recognized the opportunity: our healthcare system is legendary for its inefficiencies, complexity, and opacity – all areas that seem utterly amenable to a technology-driven solution. Yet, to date, the results have been middling at best. Why hasn’t there been a Google or a Facebook in the healthcare space?

One reason may be that existing stakeholders are more entrenched than generally appreciated; we may also be more reluctant to tinker with our health than we are to try out the latest app. It’s also likely that at least until recently, entrepreneurs were more incentivized to create expensive solutions than to engineer cost-effective ones (as this McKinsey report suggests).

Yet I’d argue that the most significant disconnect I’ve found here in Silicon Valley is a failure to understand the nature of the problem to be solved. Most engineers and computers scientists with whom I’ve spoken conceptualize medicine as primarily a rational, evidence-based, problem-solving enterprise focused on well-defined conditions, rather than a discipline that in my experience owes more to scientism than science, is far more ambiguous than most engineers tend to recognize, and is founded on relationships, connectedness, trusted advice, reassurance, and frequently the off-loading of significant responsibilities from patient to doctor. Perhaps the physician's greatest responsibility is helping to compassionately mediate the patient's experience of illness.

Simply put, medicine is so much more than simply a diagnosis and treatment (although regrettably in today’s world of rapid-fire outpatient medicine, it occasionally seems to be reduced to this cartoon), and patients -- especially those with chronic illnesses -- value more than just the rigid outcome measures traditional metrics tend to capture. A novel technology platform that overlooks the integrated needs of patients or underestimates or fails to account for the complexity and messiness of illness as it actually occurs and is experienced by patients (and those closest to them) will inevitably fall short.

This disconnect between the reality of medicine and its Silicon Valley conceptualization is especially important because technological innovation – the sort of ideas the valley was founded upon – is urgently needed in medicine, and offers the potential to radically disrupt the way we think about health and disease, and can make it easier for us to stay healthy and understand what may be ailing us when we’re sick. There’s also an urgent need for improved communication between providers so that successful approaches can be shared, and less effective approaches identified and called-out (highlighted in this BCG white paper). There’s also a growing need to adopt what might be called a network or systems view of medicine, and develop ways of integrating complex data over multiple domains to uncover new patterns and suggest new approaches to diagnosis or treatment.

An especially useful starting point for an aspiring healthcare company would be to think about ways to deliver a “positive good.” Most contemporary medicine is generally regarded, economically, as a negative good – something we use or engage in because we have to, not because we especially want to. While this creates a ready market, it’s also results in a tense and uncomfortable relationship between the “producers” of healthcare – who have often invested a significant amount of resources with the intention of making a profit – and consumers, who have little choice but to pay (or co-pay) for expensive care, and consequently tend to resent it.